AIDS no more

[Aaron]

I generally meant the fundamentalists, of which there are alot of in the US. Not to mention the neo-cons ad the simpley mis-informed. My own father-in-law believed that HIV was a gay only affliction until I set him straight.

[Mikey]

Thanks for getting my back, Teaos.

Of course that was not MY opinion! In the Northeast US, there is still an undercurrent of bigotry surrounding AIDS/HIV - I was merely reporting on it.

And most of the urban corridors have needle exchange programs. I get mine for free, thanks to good health insurance. Interestingly enough, I have taken injections in public restrooms at rest stops on the highway, sports stadiums, restaurants, etc., sometimes even next to state police officers, and nobody has ever given me a second look about it. Are type 1 diabetics who still prefer old-school vials and syringes THAT common?

[Aaron]

What's the alternative to syringes for diabetics, autoinjectors?

[Mikey]

There are "pens," which look and act like epinephrine pens - they have their own reservoir, and you just dial up the amount and inject. The insulin pump is becoming very popular, which is worn like a pager and has a small lead into a subcutaneous injection site - it carries its own s3-4 day supply of short-acting insulin. Also recently on the scene is an insulin inhaler - my endocrinologist told me that the inhaled insulin works every bit as well as injected insulin, but that the measuring and delivery mechanism is a real pain in the rear.

[Teaos]

Then why do you choose to stick pins in you everyday if there is an alternative.

[Sionnach Glic]

Perhaps because some people don't particularly mind?

[Mikey]

True - I am free of the phobia that many people have toward syringes.

However, nothing is perfect. I just recently got a Rx for the needles for my short-acting insulin - they still require sticking myself, but are easier to travel with. Many people I know use the pump, but it's not ideal for me; it requires a great deal of projection and calculation to figure exactly what bolus (insulin adjustment) to program for any particular meal, and of course then you can't eat any more or less than you had projected. In addition, when you use the pump, you no longer use a long-acting insulin, which helps shut off baseline sugar production in the liver - I'm a classic type "A", with my adrenals running full bore, 24/7 - I can't afford to be without that long-acting insulin.

The inhaler is relatively new, and I understand it controls sugar as effectively as injections, but my doctor told me that nyone he had put on it ASKED to go back to injections because of the amount of pain-in-the-assedness of the inhalation mechanism.

Besides, then I always have a supply of needles to use for my junk, right? J.K!!!

[celeritas]

Merck abandons HIV vaccine trials

International drug company Merck has halted trials on an HIV vaccine that was regarded as one of the most promising in the fight against Aids.

Merck stopped testing the vaccine after it was judged to be ineffective.

In trials, the vaccine failed to prevent HIV infections among volunteers who were at risk of catching the virus, including gay men and sex workers.

Merck had previously expressed high hopes for the drug, which it spent 10 years developing.

'Headed for failure'

Merck's international trial, called Step, began in 2004 and involved 3,000 HIV-negative volunteers from diverse backgrounds, between the ages of 18 and 45.

Merck said that 24 of 741 volunteers who got the vaccine became infected with HIV, the virus that causes Aids.

Out of a group of 762 volunteers who were given a dummy version of the jab, 21 became infected with HIV.

An independent monitoring panel recommended discontinuing the vaccination of volunteers, saying the trial was headed for failure.

Most of the volunteers were at high risk of HIV infection.

They were repeatedly given advice about how to practise safe sex, according to Merck.

The vaccine contained a common cold virus loaded with copies of three HIV genes.

The hope was that exposure to the genes would prompt an immune response in the body so that cells containing HIV virus would be recognised and destroyed.

"Today is a very sad day for the industry because Merck's vaccine had shown an ability to turn on the immune system, which gave many people optimism it would work," said Sarah Alexander, from the HIV Vaccine Trials Network.

Doctors have said a preventative vaccine would be the best way to control the spread of HIV.

ah its so hard to make a good vaccine that can generate the desired immune response but yet remain absolutely safe, cheap, and durable.

[Mikey]

Unfortunately, while seemingly so much more dangerous, HIV shares many properties with so many other, more innocuous viruses which we say day-to-day; that is, it is very small compared to bacteria or single tissue cells - although large compared to most viruses - and it is resilient and adaptive.

In addition, it (obviously) has a primary effect on the immune system. It is very difficult to affect that medically without opening a Pandora's box of other very serious medical issues. I, for example, developed Type 1 (or "juvenile") diabetes at the age of 33 due to an autoimmune reaction - my immune system eseentially attacked and defeated my own pancreas. While my case had nothing to do with HIV, and that is merely one type of example, the effectiveness of any such vaccine must be balanced with limiting its effectiveness in producing such autoimmune results.

A good analog is the early days of chemotherapy - many people know someone who was beginning to overcome cancer, only to be killed by the action of the chemotherapy itself.

[celeritas]

actually, HIV is not like your typical virus because of its retrovirus status, the ability to make DNA from RNA using a reverse transcriptase enzyme. this was something that at one point in time challenged medical dogma much like proclaiming the sun being the center of the solar system or the earth being round. your typical viruses are not retroviruses and don't move information from RNA to DNA (except for hepadnaviruses, which, like retroviruses, are also very atypical).

the vaccine as a therapy is the most desired approach but it must be designed to be absolutely safe because of the fact that you're injecting it in normally perfectly healthy people; babies no less. for example, the live-attenuated sabin vaccine for polio is actually the vaccine that triggers the best immune response and provide the best immune protection against polio. however, because it is a live-attenuated vaccine, it carries a risk, in this case about 2/1,000,000, of developing vaccine-associated paralytic polio. in the old days when people would just fall over with polio, that background infection rate was acceptable, but not anymore. so instead we have the inactivated killed salk vaccine which is 100% safe but triggers a different kind of immune response that is sufficient, but not the desired kind of immune protection (its not as good at providing mucosal IgA protection).

so back to HIV: for a virus that is capable of adapting so quickly, its difficult to find a good antigenic target for a vaccine that will trigger the proper immune response yet be absolutely safe so that nobody will die from infection, cancer, autoimmunity, or any undesired sequelae. and preferably give all its protection in one shot (many of our current vaccines use bacterial subunits or polysaccharides that, though very safe, suck at triggering an immune response, which is why you got so many shots as kid -- to get a strong enough response, you had to get multiple shots in a series).

vaccines and other immunotherapies are difficult to produce because of the complexity of the immune system and their interactions, but there have been amazing success stories in immunology such as the small pox eradication. it is becoming increasingly possible to manipulate the immune system to protect us from infectious diseases, autoimmune disease, cancer, and graft vs. host/graft rejection diseases.

While my case had nothing to do with HIV, and that is merely one type of example, the effectiveness of any such vaccine must be balanced with limiting its effectiveness in producing such autoimmune results.

of course, as mikey mentioned, you have to be careful what antigenic targets you pick for vaccines because you can get some pretty serious sequelae from a poorly designed vaccine -- not just autoimmunity but serious medical complications, actually getting the infectious disease, even cancer. its an excellent point but by no stretch of the imagination should anybody believe its somehow safer to not vaccinate their kids with the current vaccination schedule. this is actually a somewhat serious problem in the states where there are some people who somehow got the erroneous idea in their head that vaccines cause autism or something where there is no medical support for and so choose not to get their kids vaccinated, putting their children at risk for life-threatening disease.

(if you haven't figured it out yet, the idea that there are parents out there to refuse to get their kids vaccinated on the recommended vaccine schedule really annoys me. in my humble opinion, its kind of like drinking unpasteurized milk in terms of safety and being a good idea.)

[Mikey]

...by no stretch of the imagination should anybody believe its somehow safer to not vaccinate their kids with the current vaccination schedule.

Of course I was by no means implying that parents should omit anything from their kids' vaccination schedule. Even the late "mercury content = autism" anti-vaccination argument has been proven to be without merit. I know my daughter is up to date. And my case, although the particular antibodies which were my downfall were no longer detectable upon my diagnosis, probably had nothing to do with a vaccination. I was merely stating one of the hardships of developing a new vaccine - especially one designed to protect against a virus which targets the immune system. Obviously, Celeritas is much more well versed in this area than am I - and knows at least a little Latin too.

[Granitehewer]

i remember doing a survey, just your typical R meth stuff; out of the sample pool of participants; 21% of participants questioned from the local islamic community, stated that they were suspicious of and consequently rejected vaccinations, it wasn't my remit to determine why or to generalise to an overall population, and clearly some things are best not said as may be provocative and upset sensibilities...

[Mikey]

I'm sure nobody here is attemting to tell anyone to subvert their own religious beliefs. I wouldn't tell a scientologist to go to the hospital, or a Catholic to go to an abortion clinic (in fact, I probably wouldn't talk to a scientologist if it could be helped...)

What we are saying is that for people who have no ethical objections to vaccinations, the pseudo-scientific "medical" objections to them do not hold water.

[Granitehewer]

of course, but the feedback, i received but couldn't in good faith extrapolate, was that the decline in use of vaccinations by that particular community,which may not represent the greater whole, was more defined by a cultural-political attitude,than a religion. of course i wouldn't want people to negate their sacred beliefs or political ones.But religion is pertinent since a goodly part of persons who are involved in taking or have the option of taking a vaccination, will not be secular

[Aaron]

I'm sure nobody here is attemting to tell anyone to subvert their own religious beliefs. I wouldn't tell a scientologist to go to the hospital, or a Catholic to go to an abortion clinic (in fact, I probably wouldn't talk to a scientologist if it could be helped...)

What we are saying is that for people who have no ethical objections to vaccinations, the pseudo-scientific "medical" objections to them do not hold water.

Personally I think if your using your religion as an excuse not to get vaccinated than your an idiot and you deserve what you get. The really sad thing about this is that they are risking their kids lives. The objections that I see from Muslims most often however is not religion based but rather that the West is using the vaccines to sterilize their woman. Unfortunatly the loons are risking the herd immunity as well with their bullshit.

I have a great-uncle who was crippled by polio so I have personal experiance with this and feel very strongly about it. I'm even going to get my daughter the HPV vaccine when she comes of age if it isn't already manditory in Ontario.